The Value Of Dual-source Ct Renal Perfusion Imaging And Serum Cystatin C On Acute Kidney Injury On The Debakey Type â…  Aortic Dissection

Objective: To explore the value of the serum Cystatin C(Cys-C) and dual-source CT renal perfusion imaging on the acute kidney injury during the operation on Debakey type Ⅰaortic dissection, and seek to the non-invasive test about renal cortical hemodynamic changes with aortic dissection, and postoperative sensitive indicators which could reflect the early acute kidney injury of aortic dissection.Methods: To collect the cinical data about 20 patients of Debakey type Ⅰ aortic dissection in cardiac surgery of our hospital from October 2013 to October 2014,including 14 men and 6 women, aged 30 to 59, mean age(46.87±9.52 mm), heart rate(84.16±6.37) beats per min, blood pressure(137.25 ±25.21) mm Hg, disease time(21.46±11.21) hours. The exclusion criteria: 1 The clinical history of chronic kidney disease and kidney tumors, 2 The clinical history of diabetes, 3 The disease time is more than 48 hours, 4 The history of cardiac surgery, 5 The history of coronary heart disease(CHD), heart failure and cardiac shock patients.meet more than any one of that has been ruled out. All patients had been drawn blood for test the level of serum cystatin C by LEITD in 1 hour on the preoperative and postoperative.According to the levels of Cys-C, with 0.90 mg/L for normal, divided the patients into two groups, the group of Cys-C has rose(group A) and did not rose(group B). group A of 12 people and group B of 8 people. Preoperative renal perfusion imaging by the dual-source CT,scanning conditions are including voltage(120kv); current(30m As); the thickness of the collimator(2.5mm); thick(10mm); matrix(64x64); field of vision(380mm). Start scanning 1 second by 1 second interval after injection of Ipromide(370)injection delay 10-15 second, scanning altogether by 15 cyc-les, to obtain 15 pictures by each patient, and obtain the time-density curve(TDC), and calculated the both sides of the patients with renal perfusion values, take on both sides of the renal perfusion average value as the patient’s renal perfusion values. Continuously monitor patients serum creatinine levels by the time point as 1-hour before surgern, 1-hour, 24-hours, 48-hours after operation. According to the the staging criteria about acute kidney injury of KDIGO commpared to patients with the changing of serum creatinine within 48-hours, to determine whether patients complicated acute kidney injury(AKI), and all patients were divided into two groups:acute kidney injury(group AKI) and non-acute kidney injury(group NAKI). Statistics of two groups of patients’ age, sex, disease time, BMI, red blood cell transfusion volume, time of CBP, time of the aorta blocks and time of DHCA as general data, analysised the date of two groups with analysis of variance(ANOVA) and chi-square test, α=0.05, P<0.05 for no statistical significance. Dividede the patients according to the staging criteria about acute kidney injury of KDIGO into 4 groups by stage 0, 1, 2, 3. To contrast the serum cystatin C of group A and group B, using chi-square test, α= 0.05, P < 0.05 for statistical significance. Analysisde the Cys-C level and renal perfusion CT value by the Spearman rank correlation test, α=0.05, P < 0.05 for no statistical significance.Results: The two groups of patients with age(P=0.015); sex(P=0.055); disease time(P=0.255); BMI(P=0.075), red blood cells transfusion volume(P=0.015); time of CPB(P=0.005); time of aorta blocking time(P=0.025); time of DHCA(P=0.005), sex, disease time and BMI between the two groups of patients is statistical significance(P>0.05), age red blood cells transfusion volume, time of CPB, time of aorta blocking time, time of DHCA has no statistical significance(P<0.05). The correlation of Cys-C and creatinie χ2=13.23, v=3, P<0.005. inear regression component χ2a= 11.29, v=1, P<0.005, deviation from linear quantile regression χ2b=1.93 v=2, P>0.05. The correlation of Cys-C and renal perfusion imaging rs =-0.958, n=20, P < 0.005.Conclusion: The serum cystatin C has appeared increasing during the early acute kidney injury by the meaming of hemodynamic changing. The Cys-C level had the correlation with serum creatinine level after the operation. Statistical linear regression component(χ2a) has statistical significance and the deviation from linear quantile regression(χ2b) has no statistical significance. It means that Cys-C and serum creatinine had the linear correlation. Serum cystatin C can be used as a early sensitive index of acute kidney injury after the operation of aortic dissection. The cystatin C and renal perfusion value had the linear correlation, and presents the highly negative correlation. The Cys-C level in patients is higher, the worse in patients with kidney injury, and the level of renal perfusion value is lower. Patients with hemodynamic abnormalities whose renal perfusion value can be found that TDC peak delays, and some patients peak is reduced. The renal perfusion imaging coud assessed the aucte kidney injury by a certain extent.